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Chung J.W.Y.,The Hong Kong Institute of Education | Zeng Y.,Guangzhou University | Wong T.K.S.,Tung Wah College
Pain Physician | Year: 2013

Background: Low back pain (LBP) is one of the most common health problems in adults. The impact of LBP on the individual can cause loss of health status in the form of symptoms and loss of function related to pain in the back; limitation of daily, leisure, and/or strenuous activities, and disability. LBP also poses an economic burden to society, mainly in terms of one of the most common reasons for seeking medical care (direct treatment costs), and accounts for the large number of work days lost (indirect costs). To reduce the impact of LBP on adults, drug therapy is the most frequently recommended intervention. Over the last decade, a substantial number of randomized clinical trials of drug therapy for LBP have been published. Objective: To determine the effectiveness of drug therapy for the treatment of chronic nonspecific low back pain (CNLBP). Study Design: Systematic review and meta-analysis Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Five databases (Medline, CINAHL, Science Direct, CAJ Full-text Database, and Cochrane databases) were searched for articles published from 2002 to 2012. The eligibility criteria were randomized trials and double-blind controlled trials of oral or injection drug therapy for CNLBP in subjects who were aged at least 18 years old, published in English or Chinese. Two independent reviewers extracted the data. Results: A total of 25 drug therapy trials were included. cyclo-oxygenase-2 (COX-2) nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioids were commonly used. Only 5 trials studied the efficacy of adjuvant analgesics of antiepileptics (n = 1) and antidepressants (n = 4) for CNLBP. The standardized mean difference (SMD) for COX-2 NSAIDs in pain relief was -12.03 (95% confidence interval [CI]: -15.00 to -9.06). The SMD for tramadol in pain relief was -1.72 (95% CI: -3.45 to 0.01). As the 95% CI crossed 0, this effect size was not considered statistically significant. The SMD for the overall effects of opioids in pain relief was -5.18 (95% CI: -8.30 to -2.05). The SMD for the partial opioid agonist drug in pain relief was -7.46 (95% CI: -11.87 to -3.04). Limitations: The follow-up periods of these included trials in the meta-analysis ranged from 4 to 24 weeks. The difference of follow-up periods influenced how study outcomes were recorded. These included trials also had significant differences in patient selections. Some trials may actually include CNLBP patients with neuropathic pain, as not having focal neurological findings or signs does not mean that the pain is not neuropathic. Consequently, different pain conditions may influence patients who responded to the same drug and then influence pooled estimates of treatment effect size. Conclusion: This review endorses the use of COX-2 NSAIDs as the first-line drugs for CNLBP. Tramadol shows no statistically significant effect on pain relief, but has small effect sizes in improving functioning. Among included opioid therapy studies, the overall effects of opioids and the partial opioids agonist drug had statistically significant treatment effects in pain relief for CNLBP patients. Source


Tang A.C.Y.,Caritas Medical Center | Chung J.W.Y.,The Hong Kong Institute of Education | Chung J.W.Y.,Tung Wah College | Wong T.K.S.,Hong Kong Polytechnic University
Evidence-based Complementary and Alternative Medicine | Year: 2012

In view of lacking a quantifiable traditional Chinese medicine (TCM) pulse diagnostic model, a novel TCM pulse diagnostic model was introduced to quantify the pulse diagnosis. Content validation was performed with a panel of TCM doctors. Criterion validation was tested with essential hypertension. The gold standard was brachial blood pressure measured by a sphygmomanometer. Two hundred and sixty subjects were recruited (139 in the normotensive group and 121 in the hypertensive group). A TCM doctor palpated pulses at left and right cun, guan, and chi points, and quantified pulse qualities according to eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) on a visual analog scale. An artificial neural network was used to develop a pulse diagnostic model differentiating essential hypertension from normotension. Accuracy, specificity, and sensitivity were compared among various diagnostic models. About 80% accuracy was attained among all models. Their specificity and sensitivity varied, ranging from 705 to nearly 90%. It suggested that the novel TCM pulse diagnostic model was valid in terms of its content and diagnostic ability. Copyright © 2012 Anson Chui Yan Tang et al. Source


He K.,Hunan University of Science and Technology | He K.,City University of Hong Kong | Lai K.K.,City University of Hong Kong | Yen J.,Tung Wah College
Expert Systems with Applications | Year: 2012

Subject to shocks worldwide, the metals markets in the era of structural changes and globalization have seen a very competitive and volatile market environment. Proper risk measurement and management in the metals markets are of critical value to the investors belonging to different parts of the economy due to their unique role as important industry inputs to the manufacturing process. Although traditional risk management methodologies have worked in the past, we are now facing the challenge of rapidly changing market conditions. Markets now demand the methodologies that estimate more reliable and accurate VaRs. This paper proposes a Multi Resolution Analysis (MRA) based nonlinear ensemble methodology for Value at Risk Estimates (MRNEVaR). The MRA using wavelet analysis is introduced to analyze the dynamic risk evolution at a finer time scale domain and provide insights into different aspects of the underlying risk evolution. The nonlinear ensemble approach using the artificial neural network technique is introduced to determine the optimal ensemble weights and stabilize the forecasts. Performances of the proposed MRNEVaR and more traditional ARMA-GARCH VaR are evaluated and compared during empirical studies in three major metals markets using Kupiec backtesting and Diebold-Mariano test procedures. Experiment results confirm that VaR estimates produced by MRNEVaR provide superior forecasts that are significantly more reliable and accurate than traditional methods. © 2011 Elsevier Ltd. All rights reserved. Source


Zhu L.-X.,Hong Kong Polytechnic University | Ho S.-C.,Hong Kong Polytechnic University | Wong T.K.,Tung Wah College
Journal of Evidence-Based Medicine | Year: 2013

Background and Objective: Regular exercise has been shown to be beneficial to patients with heart disease. Previous studies have indicated that health education can effectively increase participants' physical activity. However, no systematic review was conducted to evaluate the effectiveness of health education programs on changing exercise behavior among patients with heart disease. The aim of this study was to examine the effectiveness of health education programs on exercise behavior among heart disease patients. Method: Potential studies were retrieved in the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMbase, PsycINFO, the British Nursing Index and Archive, Science Direct, and ERIC via EBSCOhost. Meta-analysis was done using the random-effect model. Results: Thirty-seven studies were identified. Only 12 studies delivered health education based on various theories/models. Twenty-eight studies were included in the meta-analyses. The results showed that health education had significantly positive effects on exercise adherence (risk ratio = 1.35 to 1.48), exercise duration (SMD = 0.25 to 0.69), exercise frequency (MD = 0.54 to 1.46 session/week), and exercise level (SMD = 0.25), while no significant effects were found on exercise energy expenditure and cognitive exercise behavior. Conclusion: Health education has overall positive effects on changing exercise behavior among heart disease patients. Few theoretical underpinning studies were conducted for changing exercise behavior among heart disease patients. The findings suggest that health education improves exercise behavior for heart disease patients. Health professionals should reinforce health education programs for them. © 2013 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd. Source


He K.,Hunan University of Science and Technology | Lai K.K.,City University of Hong Kong | Yen J.,Tung Wah College
Energy Economics | Year: 2011

With the increasing level of volatility in the crude oil market, the transient data feature becomes more prevalent in the market and is no longer ignorable during the risk measurement process. Since there are multiple representations for these transient data features using a set of bases available, the sparsity measure based Morphological Component Analysis (MCA) model is proposed in this paper to find the optimal combinations of representations to model these transient data features. Therefore, this paper proposes a MCA based hybrid methodology for analyzing and forecasting the risk evolution in the crude oil market. The underlying transient data components with distinct behaviors are extracted and analyzed using MCA model. The proposed algorithm incorporates these transient data features to adjust for conservative risk estimates from traditional approach based on normal market condition during its risk measurement process. The reliability and stability of Value at Risk (VaR) estimated improve as a result of finer modeling procedure in the multi frequency and time domain while maintaining competent accuracy level, as supported by empirical studies in the representative West Taxes Intermediate (WTI) and Brent crude oil market. © 2011 Elsevier B.V. Source

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